Provider Demographics
NPI:1548200660
Name:SOTO, EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:SOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 CALLE BURGOS
Mailing Address - Street 2:SAN JOSE
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-1345
Mailing Address - Country:US
Mailing Address - Phone:787-764-4162
Mailing Address - Fax:
Practice Address - Street 1:369 CALLE BURGOS
Practice Address - Street 2:SAN JOSE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-1345
Practice Address - Country:US
Practice Address - Phone:787-764-4162
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine